Carotid artery intimamedia thickness and HIV infection: traditional risk factors overshadow impact of protease inhibitor exposure

Currier, Judith Sa; Kendall, Michelle Ab; Zackin, Robertb,†; Henry, W Keithc; Alston-Smith, Beverlyd; Torriani, Francesca Je; Schouten, Jefff; Mickelberg, Keithg; Li, Yanjieh; Hodis, Howard Nh; for the AACTG 5078 Study Team

Clinical Science

Context: The impact of HIV infection and exposure to antiretroviral therapy on the development of subclinical atherosclerosis is incompletely understood.

Objective: To compare intima–media thickness (IMT) of the carotid artery between HIV-infected subjects receiving protease inhibitor-containing regimens and subjects not receiving these regimens and to compare differences in the IMT of the carotid artery between HIV-infected subjects and HIV-uninfected subjects.

Methods: A prospective matched cohort study in university-based outpatient clinics. Groups of three individuals (triads) matched on the following characteristics were enrolled: age, sex, race/ethnicity, smoking status, blood pressure and menopausal status. Group 1, HIV-infected subjects with continuous use of protease inhibitor (PI) therapy for ≥ 2 years; group 2, HIV-infected subjects without prior PI use; and group 3: HIV-uninfected. Ultrasonographers at six sites sent standardized ultrasound images to a central reading site for carotid IMT measurements. Carotid IMT was compared within the HIV-infected groups (1 and 2) and between the HIV-infected and uninfected groups in a matched analysis.

Results: One hundred and thirty-four individuals were enrolled in 45 triads. The median IMT in groups 1, 2 and 3 was 0.690, 0.712 and 0.698 mm, respectively. There were no statistically significant differences in IMT between groups 1 and 2, or in the combined HIV groups compared with the HIV uninfected group. Significant predictors of carotid IMT in a multivariate model included high-density lipoprotein (HDL) cholesterol, the interaction of HDL cholesterol and triglycerides, age and body mass index.

Conclusions: We found no association between PI inhibitor exposure or HIV infection and carotid IMT.

From the aCenter for Clinical AIDS Research and Education, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California

bStatistical & Data Analysis Center, Harvard School of Public Health, Boston, Massachusetts

cHIV Program, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota

dDivision of AIDS, National Institutes of Allergy and Infectious Diseases, NIH, Bethesda, Maryland

eDivision of Infectious Diseases, Department of Medicine, University of California, San Diego, California

fDepartment of General Surgery, University of Washington, Seattle, Washington

gAIDS Clinical Trials Unit, University of Pennsylvania

hAtherosclerosis Research Unit, Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, USA.

We mourn the loss of our colleague and friend, Dr Robert Zackin, who passed away on 2 September 2004. He will be remembered for his commitment to improving the lives of people with HIV infection and for his outstanding contributions to AIDS research.

Received 2 September, 2004

Revised 14 October, 2004

Accepted 8 November, 2004

Correspondence to Judith S. Currier, MD, UCLA CARE Center, BH-412, CHS, 10833 Le Conte Ave, Los Angeles, CA 90095, USA. E-mail: jscurrier@mednet.ucla.edu

© 2005 Lippincott Williams & Wilkins, Inc.